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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397005339
Report Date: 05/16/2023
Date Signed: 05/16/2023 11:28:22 AM

Document Has Been Signed on 05/16/2023 11:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:STARTING OUTFACILITY NUMBER:
397005339
ADMINISTRATOR:MIA CHATMAN-JAMESFACILITY TYPE:
775
ADDRESS:41 W YOKUTS AVENUETELEPHONE:
(209) 476-1170
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY: 120CENSUS: 6DATE:
05/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Mia Chatman - James/ Program ManagerTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Annual Inspection Visit. LPA met with Program Manager (PM) and stated the purpose of today’s visit. LPA was allowed entry into the facility and was accompanied by PM throughout the inspection tour of the facility that is licensed to serve a total capacity of hundred and twenty clients. Today's census is 18 clients enrolled in remote alternative services and six clients on site. Facility recently has allowed clients back on day program site, but most clients are still served remotely.

The are seven classrooms for activities, four restrooms, staff office, break room, kitchen and storage areas. LPA observed tables and chairs to serve the capacity of the day program. LPA observed medications room locked with a medications cart to store centrally stored medications, but none currently. LPA observed areas where staff prepare packets to be delivered to clients. LPA and program manager toured physical plant inside and outside to ensure the safety of the clients. The temperature inside the facility was measured at 72*F which is within the required range of 68*F and 85*F. The hot water was measured at 109.4*F which is within regulatory range of 105*F and 120*F. LPA observed a pull alarm system and fire extinguisher(s) expire 3/31/2024, smoke and carbon monoxide detectors, central heating and air in the facility. LPA reviewed three client files and staff three files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews.

LPA Wallace received update document on today's date:
Designation of Administrative Responsibility - LIC308

Per the California Code of Regulations, Title 22, Division 6, no deficiencies observed or cited.
Exit interview held with PM, copy of report given.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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